一个简单的风险指数,用于对ST升高心肌梗塞患者进行快速初始分组:InTIME II子研究
D A Morrow1, E M Antman, R P Giugliano
1TIMI Trials Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA. damorrow@bics.bwh.harvard.edu
Lancet (London, England)
|November 22, 2001
概括
使用年龄,心率和缩血压的简单风险指数准确预测ST升高心肌梗塞 (STEMI) 患者的死亡率. 这种工具有助于快速分类,以获得更好的紧急心脏护理.
科学领域:
- 心脏病学 心脏病学
- 紧急医疗 紧急医疗
- 临床风险预测预测
背景情况:
- 有效的分组对ST升高心肌梗塞 (STEMI) 患者的结果至关重要.
- 现有的STEMI死亡率预测模型很复杂,经常使用许多变量.
- 年龄,心率和血压始终是STEMI死亡率的强有力的预测因素.
研究的目的:
- 开发和验证一种简单的风险指数,用于预测STEMI患者的30天死亡率.
- 评估该指数在快速临床分类中的有用性.
- 为了确定一个简单的索引是否可以捕捉到重要的预后信息.
主要方法:
- 从InTIME II试验 (n=13,253) 中使用年龄,心率和静心血压 (SBP) 开发了一个风险指数.
- 公式: (心率x [年龄/10]) /SBP.
- 在TIMI 9试验 (n=3659) 的独立队列中验证了该指数.
主要成果:
- 风险指数强烈且独立地预测死亡率 (c-统计=0.78).
- 分类为五分之一显示死亡率梯度>20倍 (0.8%至17.4%).
- 该指数准确地预测了非常早期的事件 (24小时内死亡,c-statistic=0.81),并显示了强大的外部验证.
结论:
- 使用易于评估的变量的简单风险指数有效预测STEMI死亡率.
- 与复杂模型相比,该工具简化了风险分层.
- 该指数对于在医院前和医院内对STEMI患者进行快速分拣非常有价值.
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